Snakebites from Protobothrops mucrosquamatus (Taiwan habus) and Viridovipera stejnegeri (green bamboo vipers) account for the most venomous snakebites in Taiwan. The bivalent freeze-dried hemorrhagic (FH) antivenom is employed to treat these two snakebite patients without a strict clinical trial. We evaluated the clinical usefulness of Taiwan bivalent freeze-dried hemorrhagic (FH) antivenom in Taiwan habu- and green bamboo viper-envenomed patients. We checked ELISA- based serum venom antigen levels before and after FH antivenom to evaluate FH’s ability to neutralize patients’ serum snake venom and its usefulness in reducing limb swelling after snakebites. Patients who had higher serum venom antigen levels had more severe limb swelling. Of the 33 enrolled patients, most of their snake venom antigen levels were undetected after the appliance of antivenom. Most enrolled patients (25/33) had their limb swelling subside within 12 h after antivenom treatment. The failure to reduce limb swelling was probably due to an inadequate antivenom dose applied in more severely envenomated patients. Our data indicate the feasibility of the FH antivenom in effectively eliminating venom and resolving the affected limb swelling caused by Taiwan habu and green bamboo viper bites.

Since excessive alcohol consumption is a shared risk factor for esophageal cancer and liver fibrosis, it is possible that patients with esophageal cancer may develop unknown liver fibrosis or cirrhosis. We applied preoperative transient elastography (TE) to patients without recorded cirrhosis undergoing esophagectomy to clarify the validity in predicting postesophagectomy hepatic failure. The cohort consisted of 107 patients who received TE before esophagectomy between June 2018 and December 2021. Patients were categorized into two groups based on the fibrosis score yielded by preoperative TE (mild group: 0~2, n = 92; severe group: 3~4, n = 15). There was no significant difference in demographic data nor surgical variables between the two groups. None of the cohort encountered hepatic failure, yet the severe fibrosis group had a significantly higher rate of pleural effusion (40.0% versus 15.2%, p = 0.03). The areas under the curve (AUCs) of TE in predicting postoperative complications and 180-day mortality were 0.60 (95% CI: 0.46–0.74) and 0.67 (95% CI: 0.51–0.83), respectively. In conclusion, stratification of patients with esophageal cancer who had liver fibrosis by preoperative TE demonstrates significant validity in predicting postoperative pleural effusions. Recruitment of noncirrhotic patients with higher TE scores is warranted to examine its power in other parameters.

Taiwan habu (Protobothrops mucrosquamatus), green bamboo viper (Viridovipera stejnegeri), and Taiwan cobra (Naja atra) are the most venomous snakebites in Taiwan. Patients commonly present with limb swelling but misdiagnosis rates are high, and currently available diagnostic tools are limited. This study explores the immune responses in snakebite patients to aid in differential diagnosis. This prospective observational study investigated the changes in cytokines in snakebite patients and their potential for diagnosis. Elevated pro-inflammatory cytokines IL-6 and TNF-α were observed in all snakebite patients compared to the healthy control group. While no significant disparities were observed in humoral immune response cytokines, there were significant differences in IFN-γ levels, with significantly higher IL-10 levels in patients bitten by cobras. Patients with TNF-α levels exceeding 3.02 pg/mL were more likely to have been bitten by a cobra. This study sheds light on the immune responses triggered by various venomous snakebites, emphasizing the potential of cytokine patterns for snakebite-type differentiation. Larger studies are needed to validate these findings for clinical use, ultimately improving snakebite diagnosis and treatment.

Background/Objectives: Extracorporeal membrane oxygenation (ECMO) use has increased worldwide, yet in-hospital mortality among adult recipients remains substantial. Large-scale evidence examining patient- and treatment-related factors associated with mortality in real-world settings is still limited. This study aimed to quantify in-hospital mortality and identify factors associated with mortality among adults receiving ECMO using a nationwide cohort in Taiwan. Methods: We conducted a retrospective nationwide cohort study using Taiwan’s National Health Insurance Research Database, including adults (≥18 years) who received ECMO during hospitalization between 2011 and 2020. ECMO indication groups were defined using ICD-9-CM (before 2016) and ICD-10-CM (2016 onward) codes and further classified into four mutually exclusive categories. Multivariable logistic regression was used to examine factors associated with in-hospital mortality. Results: Among 15,151 adults treated with ECMO, 9657 (63.7%) died during hospitalization. In multivariable analyses, higher odds of in-hospital mortality were associated with older age, higher comorbidity burden (Charlson Comorbidity Index ≥3), and use of multiple ECMO machines (≥2). Compared with patients without cardiopulmonary indications, those classified as cardiogenic shock alone or combined respiratory failure and cardiogenic shock had lower adjusted odds of in-hospital mortality. Longer hospital length of stay was inversely associated with in-hospital mortality, reflecting differing care trajectories among ECMO recipients. Conclusions: In this nationwide real-world cohort of adult ECMO recipients, in-hospital mortality was high, and mortality risk was associated with patient age, comorbidity burden, ECMO treatment complexity, and diagnosis-based indication classification. These findings provide population-level insight into mortality patterns and may inform risk communication and system-level planning for ECMO care.

With an aging global population, falls are a major health concern, leading to more injuries and higher healthcare costs. Exercise is vital to keep older ad

The World Stroke Organization1 indicates that stroke is the second leading cause of death and the third leading cause of combined death and disability worldwide among non-communicable diseases. A s...